The present invention is generally in the field of kits, and more specifically concerns kits for domestic use for the self-detection of various physiological conditions.
Parasitology is one of the very few remaining tests in clinical medicine which relies on the visual recognition skills of a trained technologist. It involves, in fact, two visual recognition skills. One is the identification of particular morphological features characterizing an organism as belonging to a certain species, and being able to recognize it by name. The other, and much more difficult skill is the ability to recognize old, young, damaged, deformed, or even partially degraded organismsxe2x80x94perhaps occurring only at the edge of a microscopic fieldxe2x80x94and know that it is a particular parasite. Such being the case, a negative result for a parasitology test only indicates that no parasite was found, and can not be conclusive that a patient is negative for parasites.
The problem of parasite identification for the laboratory is additionally difficult due to the fact that parasite frequency can vary widely, and may not have any relation to severity of disease. Parasite reports are typically graded from rare to many. It is possible, in fact for a person to have a serious parsitological infestation, but to have only infrequent, periodic, or occasional shedding of parasitic organisms. In the case of low frequency of occurrence in the stool, organisms may or may not be present in the particular specimens being examined under the microscope.
The problem of parasite identification for the laboratory is additionally complicated due to the fact that transportation of specimens from the patient to the clinical laboratory is usually delayed and during this delay the parasites may die or be degraded, thus decreasing even further the chances of identification.
Thus, the situation exists where many clinical laboratories fail to detect parasites which, in fact, are present in patient specimens. Clinical laboratory surveys in the United States frequently report a positive prevalence of parasites of 1-3%, and rarely over 5%. Yet various published studies by specialty, or university based laboratories, show that the true positive rate can be as much as 4- or 5-fold higher than
In response to this situation, parasitologists have developed methods of concentrating parasites and staining them with contrasting colors so as to improve recognition ability. Thus, a concentration procedure followed by a trichrome staining procedure has been developed as the standard method of properly performed parasitology analysis. This method, however, is laborious and time consuming. It is, therefore, not done by all labs all the time, in spite of recommendations to that effect. Even when performed, it does not address or solve all the problems mentioned above.
In recognition of this situation diagnostic device companies have developed tests for particular parasites. Notably tests for giardia lamblia, entamoeba histolytica, and cryptosporidium sp. are commercially available. These take two forms, either being an ELISA test (i.e.: Alexon-Trend, Inc), or fluorescent tagging of the organisms followed by direct microscopic examination (ie:Meridian Diagnostics, Inc). The problem with these tests, however, is that they attempt to identify a particular organism, and not all organisms or the overall presence of parasites. Furthermore these tests require laboratory procedures and the intervention of skilled technicians.
The nature of parasite examination, and prevalence in the world, divides the parasites into two large groups: protozoans, and worms and eggs. Protozoans are single celled organisms, and are the most common parasites found in developed countries of the world. They are, also, as a rule, smaller than worms and eggs, and are examined on high power (40xc3x97) of the microscope. Worms and eggs on the other hand are multi-cellular organisms, and are very common in underdeveloped countries of the world. They are, as a rule, larger than protozoans and are examined at low power (10xc3x97) of the microscope.
What is needed by medical science and the market, therefore, are two testsxe2x80x94one for protozoans, and one for worms and eggs. It would be sufficient to identify those specimens which are positive and differentiate them from those that are negative. It would be even more advantageous, however, to identify specifically those particular parasites which are present in each specimen.
The present invention is based on the realization that there is a need for a non-invasive, fast, accurate, and user friendly method for diagnosing the presence of parasites, both protozoan and non-protozoan, in stool. The need is especially evident in view of the high false negative diagnosis of many standard laboratory tests and the high level of skill required to identify, under a microscope the instance and type of the parasite. The present invention is further based on the realization that detection of the presence of parasites in stool is of the type of detections which may be carried out at home, or at a doctor""s clinic, without involving an analyzing laboratory, since the patient (or doctor) can easily understand a positive result of such a test, and proceeds to treat the parasite, with consultation with a doctor by the administration of anti-parasitic compounds. Furthermore, there is a great advantage of detecting parasites in fresh stool instead of waiting until the parasite reaches the laboratory resulting many times in non-viable or degraded parasites.
The present invention is further based on the realization that it is possible to develop a kit for such a non-invasive, reliable and home (and practitioner""s office) testing.
Thus the present invention by its first aspect concerns a home kit for detection of the presence of a parasite in a stool sample, the kit comprising:
(a) a vessel for mixing a stool specimen with a diluting liquid to produce a diluted stool specimen;
(b) a housing holding within a substrate, the substrate comprising at least one zone containing at least one anti-parasitic antibody, the housing further comprising reagents for producing a visually detected reaction when an antibody-parasite antigen complex is formed, the housing further comprising at least one conveying means for receiving diluted stool specimen and transferring it to the anti-parasitic antibody containing zone of the substrate;
(c) the housing further comprises an indicator for showing the presence of the visually detected reaction.
Preferably the anti-parasitic antibodies are polyclonal, in order to ensure that they interact effectively with all varieties of a specific specie of parasites. The antibodies may be prepared by any method known in the art, for example, by immunizing an animal with a suitable parasite or an immunogenic portion thereof, and then collecting the antibodies produced. Where the antibody is monoclonal, it should be against a conserved epitope of the specific parasite spears which is common to any many varieties of the parasite species as possible.
The antibodies may be against an immunogenic epitope present on the external surface of the protozoa or non-protozoa parasite, or against an immunogenic epitope of a compound shed of secreted from the parasites, such as parasite eggs.
The term xe2x80x9chome kitxe2x80x9d in the context of the present invention refers to the fact that the kit of the invention, and the detection reaction produced therein, does not necessitate any complicated machinery for collecting the specimen and preparing it, for positioning the specimen in the kit, and for reading and interpreting the resultsxe2x80x94and typically, the results can be viewed by the naked eye, or by simple optical reactor. The term does not necessarily mean that the kit is only operable at home, since due to its non-invasiveness and it is easy, user friendly manner of operation, it can be also used in a practitioner""s office or even in hospitals without involving an analytical laboratory.
The kit of the present invention comprises a vessel in which a small amount of stool specimen can be placed and diluted by a suitable diluting liquid. The vessel can then be sealed and the stool and diluting liquid shaken to produce a diluted stool specimen. The diluting liquid may be plain tap water, but according to a preferred embodiment of the invention the diluting liquid is, saline, distilled water, 10% formalin solution, sodium acetate solution with or without detergent and the like, and this diluting liquid is also provided as part of the kit""s present invention, either a priori present inside the vessel or in a separate container.
The vessel may be for example in the form of a regular capped tube, having graduations, which indicate the volume of the raw stool specimen which is to be placed inside the tube, as well as the amount of the diluting liquid to be added.
The kit may also comprise a construction for collecting the stool, such as a disposable sheet to be placed inside a toilet bowl, a disposable vessel for stool collection, etc., as well as a scooping device, for example in the shape of a small spoon to pick a determined amount of stool. The scooping device (scoop) may be an integral part of the vessel""s cap.
The kit""s main component is a housing which holds within a substrate. For example the housing may be a plastic container. The substrate may be sandwiched between two layers of the plastic container. On a predefined zone of the substrate are present antibodies against at least one parasite, and by a preferred embodiment they are immobilized on that zone. Examples of the substrates are absorbent material such as nitrocellulose sheets, gel-films, cellulose acetate, fiberglass sheet, paper, agarose gels, and in general any media featuring capillary force or absorbent forces of fluid. Typically the housing has at least one conveying means which can receive the diluted stool specimen and transfer it to said zone. The conveying of the liquid may be by capillary or absorbing flow, which are due to the inherent properties of substrate, or the inherent properties of a specifically desired layer or by the construction of specific flow channels which bring the fluid to the antibody-containing zone.
By one option the conveying means are a combination of an opening in the container which opening is associated with a construction which can transfer to diluted stool specimen to the zone on the substrate which holds the anti-parasite antibody and where the antibody-antigen interaction takes place. For example, the conveying means are in the shape of an opening in the housing through which a small amount of the diluted stool can be poured. The stool is then transferred to the antibody containing zone of the substrate, for example, by capillary forces either of the substrate itself (which is made of absorbent material) or by capillary or absorbent forces of a specially designed layer which sole purpose is to transfer the diluted stool to the antibody-containing zone, or by flow in specially designed channels.
By another option the conveying means is an absorbent material or material composed of capillaries which protrudes out of the housing, for example, an absorbent wick protruding out of an opening in the housing. In such a case the protruding substrate material is dipped in the diluted stool and due to capillary forces the liquid is transferred to the antibody-containing zone which is present inside the housing.
The anti-parasite antibodies may be immobilized on the substrate by any interaction such as covalent bonds, hydrogen bonds, electrostatic forces contained within voids of beads, etc.
Typically, large particles have to be filtered out of the diluted stool before the diluted stool is conveyed to the antibody-containing zone of the substrate. Said filtering may take place in the vessel itself, for example by constructing a two part cap: the more distal part serving as a seal, which hermetically closes the vessel and allows the user to vigorously mix its contents. However, this cap may be opened fully or partially to expose below a filter sieve which can ensure that only relatively small particles are poured from the vessel into the convening means.
Alternatively, the housing itself may comprise said filtering sieve, which for example may be present either at the mouth of the opening of the convening means, or may be present as a continuous filter sieve layer above the substrate zone on which the anti-parasite antibodies are present.
By a preferred option where the substrate is an absorbent material, the stool particles may be sieved on its upper layers of the substrate so that a filtered specimen reaches the layer of immobilized antigen.
By one embodiment, the kit may comprise a single parasite in stool antigen and in such a case it can give a binary (yes/no) indication, whether the stool contains that parasite. Alternatively, the indication may be quantitative, for example, by giving three shades of the same colorxe2x80x94a darker shade indicating xe2x80x9chighxe2x80x9d (amount of parasites in stool), than medium shade xe2x80x9cmediumxe2x80x9d, and light shade xe2x80x9clowxe2x80x9d.
By a preferred embodiment, the kit of the present invention is used to detect a plurality of different parasites, and in such a case it is possible to determine, in a single assay, whether the individual has a parasite in his/her stool and which type.
Kits in accordance with a preferred embodiment are generally divided into two groups according to the parasites to be detected; kits or the detection of protozoa parasites and kits for the detection of non-protozoa parasites.
The kits for the detection of fecal protozoan parasites are for the detection of protozoa (single cell parasite): Amoeba histolytica, Amoeba hartmanni, Amoeba coli, Amoeba nana, Giardia lamblia, , Cryptosporidium sp., Blastocystis hominis, Chilomastix mesnili, lodamoeba butschlii, Dientamoeba fragillis. 
The kits for the detection of fecal non-protozoan parasites are for the detection of Platyhelminthes (flat worms): flukes (liver, intestines, lungs and blood) and tapeworms (intestines), Nemathelminthes (round worms); Strongyloides, Trichuris, Trichinella, Pin worms, Ascaris, et al.
Preferably the kits of the invention are for the detection of protozoa parasites.
The kits of the invention may be used for human and veterinary usage. Many times domestic animals and pets suffer from the same parasite problems as humans and the kit of the invention may be used to detect parasites in animal stools.
Typically, regions of the substrate surrounding the zone on which the anti-parasite is immobilized are saturated by non-specific hydrophilic polymers such as bovine serum albumin, other proteins, or polyethylene glycol to block unspecific binding of the antibody to the substrate.
Interaction between the anti-parasite antibodies, a priori present in the kit, and parasites or parasitic components (for example, epitopes shed or secreted by parasites, for example, eggs which are present in the stool specimen, yields an antigen-antibody complex. In the kit of the invention the presence of such a complex should produce a visually detected reactionxe2x80x94i.e. a reaction which produces a visible indication, which may be viewed either by the naked eye, or by an optical reader. Examples of such a reaction is a color reaction (achieved by ELISA method) or a precipitation reaction which can easily be detected. A plurality of methods for producing visually detected reaction for antigen-antibody complexes are well known in the art, for example, as specified in xe2x80x9cImmunoassay Handbookxe2x80x9d. by David Wild, 2nd Edition, Nature Publishing Group, pp 159-175, 271-277). An example is indirect ELISA, a procedure which is used to identify the presence of the stool antigen utilizing, for example, antibodies against the parasites conjugated to a visually detectable moiety (such as gold particles) or conjugated to an enzyme producing a color reactor). Another possibility is by detection of the presence of antibody-antigen aggregates, by visually detectable precipitation reaction.
The indicator is typically an opening in the housing (xe2x80x9ca windowxe2x80x9d), which allows direct viewing of the visually detected reaction. Typically the opening is immediately above the region on which the antibodies are immobilized. The view may be by the naked eye, for example, by the detection of a colored bar, or a colored dot, or alternatively may be viewed by an optical reader, to increase sensitivity.
Where a single parasite is to be detected, a single indicator can be used which when showing the indicator (color bar, dot, etc.) indicates that there exists the specific parasite in the stool.
Where a plurality of parasites are to be detected, a plurality of indicators (windows) can be used so that each indicator is associated with a single parasite. Alternatively, a single indicator giving different readings can be used wherein each reading is in accordance with the specific antigen-antibody complex formed and thus each reading is indicative of a different parasites, present in the sample.
For example, where five different parasites are to be tested, it is possible to construct a housing with five different and separate anti-parasite-antibody containing substrate zones, so that in each zone a different anti-parasite-antibody will be immobilized, and for each zone there will be associated a separate indicator. This will ensure that the visually detected reaction in each zone is specific to the anti-parasite antibody (and hence parasite) present on the substrate of said zone, and the indicator (xe2x80x9cwindowxe2x80x9d) will simply be specifically associated with each zone. In the above case the housing may have a single means convening for example in the form of an absorbent layer.
The liquid stool specimen is poured into an opening, and due to the fact that the substrate is absorbent, capillary forces present in the absorbent material, cause transfer of the diluted stool specimen through all the separate zones on which are immobilized different anti-parasite antibodies. Then, the specific visually detected reaction is formed in each separate zone which reaction can be viewed by the specific indicator associated with that zone (for example by a xe2x80x9cwindowxe2x80x9d in the container through which a colored bead can be viewed).
In accordance with a preferred embodiment of the invention, the kit also contains internal control. The internal control is composed of those parasitic epitopes which specifically interact with the immobilized antibodies, present a priori, in the zone of the antibodies. The purpose of these, a priori, present parasitic antigens, is to form aggregates with the anti-parasitic antibody, to produce a visually detected reaction, in order to determine that the reagents used for producing the reaction are functioning properly.
The antibodies detected by the kit of the invention may be any antibody, monoclonal or polyclonal against a parasite.
As indicated above, polyclonal antibodies are preferred for ensuring that they react with all varieties of the species of parasites tested. Monoclonal antibodies are used and they should be directed against an epitope conserved in all varieties of the parasite species.
The present invention also concerns a method for detecting the presence of a parasite in a stool sample, the method comprising:
(a) obtaining a stool specimen;
(b) diluting the stool specimen with a diluting liquid to produce a diluted stool specimen;
(c) introducing the stool specimen into the kit of the invention; and
(d) viewing the indicator, the presence of a visually detected reaction in the indicator, indicating the presence of the parasite in the stool.